Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

S. Ubels*, M. Verstegen, B. Klarenbeek, S. Bouwense, M.V. Henegouwen, F. Daams, M.J. van Det, E.A. Griffiths, J.W. Haveman, J. Heisterkamp, R. Koshy, G. Nieuwenhuijzen, F. Polat, P.D. Siersema, P. Singh, B. Wijnhoven, G. Hannink, F. van Workum, C. Rosman, TENTACLE-Esophagus Collaborative Group

*Corresponding author for this work

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Background Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. Methods This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Results Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. Conclusion The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.The Severity of oEsophageal Anastomotic Leak (SEAL) score was developed using data from the TENTACLE-Esophagus study, an international, multicentre retrospective cohort study including 1509 patients with anastomotic leak after oesophagectomy. The SEAL score was developed to determine anastomotic leak severity at diagnosis, and combines 12 leak-related parameters at diagnosis. The score may be useful in clinical practice and could improve future research.
Original languageEnglish
Pages (from-to)864-871
Number of pages9
JournalBritish Journal of Surgery
Issue number9
Early online date27 Jun 2022
Publication statusPublished - 16 Aug 2022


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